Physician Care in a Hospital Setting |

Physician Care in a Hospital Setting

Kimberly Parker
Sierra Nevada Memorial Hospital Foundation

10 things to consider before hospital discharge:

1. Is there someone who will advocate for my care as I transition home?

2. Do I need any kind of care after my hospital stay?

3. What medications should I take, and what medication schedule should I follow at home?

4. What activities am I allowed to do or what activities should I avoid?

5. Do I have any dietary restrictions or nutritional requirements?

6. What medical equipment will I need at home?

7. Do I have follow-up medical appointments, and when are those?

8. What resources are available to me to help with my care at home?

9. Will I be hearing from anybody else from the hospital, and when would I expect to hear from them?

10. What red flags or changes in my condition should I watch for?

The term hospitalist was first coined by Robert Wachter and Lee Goldman in a 1996 New England Journal of Medicine article to refer to physicians whose primary professional focus is on general medical care of inpatients in a hospital.

Hospitalist training includes a four-year Bachelor’s degree followed by medical school to get an MD or a DO (Doctor of Osteopathic Medicine).

Upon completion, either an Internal Medicine three-year residency or a three-year family practice residency must be completed. Physicians then take a board certification exam. Some Hospitalists do additional fellowship training, such as a one-year specialization in geriatrics.

The medical group that provides hospitalists at Dignity Health Sierra Nevada Memorial Hospital are part of Sound Physicians. Dr. Nathan Claydon serves as the Chief Hospitalist for the group along with nine other physicians. Sandy Lewis is their local administrator.

According to the Centers for Disease Control and Prevention, on Jan. 21, the first U.S. case of the deadly coronavirus was reported in Washington state. Originating in Wuhan, China, the month prior, the coronavirus had already impacted hundreds in Asia, raising concerns internationally.

Located in Washington state and local to the first diagnosed case, Chief Hospitalist with Sound Physicians, Dr. Farshid Rafatnia has been able to provide information on how to manage this virus in a hospital setting to Sound Physicians throughout all of their geographic regions.

Dr. Claydon feels confident that his team is prepared for what is to come. “While there are a lot of unknowns, having Sound Physicians in geographic regions that are currently managing the coronavirus provides an opportunity for us to learn from their direct experiences.”

Dr. Claydon emphasized the importance of good communication between the patient, Hospitalist, nursing staff, primary care physician and specialists in all medical situations.

“Having family members involved in a discussion can be helpful as I’m not always sure a patient that is extremely ill can process information to make an informed decision.”

SNMH Chief Medical Officer Jeffrey Rosenburg works closely with this team of in-house physicians on a daily basis and shared their importance.

“The use of Hospitalists is essential as many patients that end up in the hospital have complicated cases. They may have multiple health conditions occurring at once, making Hospitalists incredibly valuable. Unlike specialists that work solely with one organ system or a certain patient demographic, Hospitalists see it all. But they also refer patients to specialists when needed.” 

A Hospitalist sees each patient at least one time per day, but they are in constant contact with the nurse either by phone or in person. There is a Hospitalist in the hospital 24 hours a day. They are available to every patient as needed. The Hospitalist also has a nurse specialist who is available to visit the patient every day as needed. If a patient requires more than one visit a day by the doctor, that will be accommodated.

Hospitalists frequently call the Primary Care Physician to inform them of a patient’s condition. The PCP receives all electronic documentation including history and physical and discharge summary. The PCP also receives lab, x-ray, and all other testing information during the hospital visit. Depending on next steps, the Hospitalist frequently calls the PCP upon discharge.

As health care changed and it became more difficult for community physicians to visit their patients in the hospital, the role of Hospitalists evolved. One of the biggest advantages is having a physician onsite 24 hours a day who understands how things work within the hospital and only take care of hospitalized patients.

The Hospitalist has authority to call any needed specialty consultation. The Hospitalist admits patients and is able to arrange for transfers to other hospitals for a higher level of care when needed such as a heart catheterization, etc.

The SNMH Hospitalists are highly focused on the personalized, expert care that they provide to the patients. They are proud of the outstanding quality results that they achieve for their patients such as sepsis care, blood transfusion protocols, intensive care evaluations, glycemic management for diabetes, and substance abuse treatments, just to name a few.

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